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Chapter 16. Vestibular and Balance Disorders

After a horizontal head shake test, the patient is observed to have downbeating nystagmus also known as “cross-coupling.” What is the most important consideration to be drawn?

A. There is symmetric involvement of bilateral horizontal semicircular canal function.

B. There is pathology involving the superior SCCs.

C. There is pathology involving the posterior SCCs.

D. The direction of nystagmus is probably not important.

E. Exclusion of a CNS disorder is required.

In a patient with CABV which single clinical test would be the most informative?

A. VOR test

B. Optokinetic test

C. VOR cancellation test

D. Test of smooth pursuit

E. Visually-enhanced VOR (VVOR) test

In which scenario is vestibular testing not necessarily indicated?

A. A case of Meniere disease whose site of involvement has not been identified through history and physical examination

B. A case of classic BPPV with a positive Hallpike test

C. A case of vestibular schwannoma who is scheduled to undergo microsurgical removal

D. A case of Meniere disease who has undergone gentamicin ablation therapy but failed treatment

E. Before starting vestibular rehabilitation therapy for suspected CABV.

In the case of a symptomatic superior semicircular dehiscence which one of the following would not be expected?

A. Decreased threshold in cVEMP responses

B. Decreased amplitude of oVEMP responses

C. Increased SP/AP ratio on ECOG with and without straining

D. A negative fistula test

E. Disequilibrium following loud-noise exposure

Which laboratory vestibular tests infer information concerning inferior vestibular nerve function?

A. cVEMP testing

B. oVEMP testing

C. Head heave test

D. Rotational chair testing

E. Caloric testing

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